OP0245 THE EFFECTIVENESS OF AN OSTEOPOROSIS REFRACTURE PREVENTION PROGRAMME – A COMPARISON OF TWO AUSTRALIAN RURAL CENTRES USING POPULATION DATABASE LINKAGE
Authors: P. Wong, A. Roberts, T. Ho, J. Thompson, J. Williamson, L. Hay
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Despite widespread availability of effective bone protective medications and knowledge that minimal trauma fractures (MTFs) identify those at high risk of re-fracture, treatment of osteoporosis following MTF is poor. An effective way to address this gap is establishment of a fracture liaison service (FLS) where a fracture liaison coordinator coordinates case-finding and bone health management, usually in collaboration with a local medical "champion". <h3>Objectives</h3> To determine the effect of a Fracture Liaison Service (FLS)/Osteoporosis Refracture Prevention (ORP) programme on refracture rates. <h3>Methods</h3> Coffs Harbour (population 80 000) on the mid-north coast of New South Wales (NSW, Australia's most populous state), had a FLS established in July 2012. The comparator was the similar-sized city of Port Macquarie, located 160 km south which did not have an FLS established until 2019. The study population was residents aged ≥ 50 years with a fracture diagnosis recorded on admission to hospital, or on discharge without an admission record by the Emergency Department (ED) between the financial years of 2007/08 and 2017/18. Refracture rates were calculated for those with a recorded index fracture using NSW Health hospital admission and ED presentation data. Cumulative refracture rates were calculated using Kaplan–Meier methods accounting for follow-up time and deaths and adjusted for age, sex and fracture type. Trends in one- to five-year cumulative refracture rates from year of index fracture were also calculated. Annual health service utilisation associated with refracture was calculated using the total number of public hospital admissions, ED presentations and outpatient service events. Any admission or ED presentation with a fracture diagnosis occurring within 28 days of index fracture or refracture was considered part of the same episode of care. <h3>Results</h3> In those aged ≥50 yo, compared to "business and usual" (BAU), there was a 7% reduction in total fractures (n=6190 observed, versus n=6628 projected BAU, 95% confidence interval [95CI] 6270 - 6985; p=0.02) and a 9% reduction in total refractures (n=1709 observed, versus 1869 projected BAU, 95%CI 1768 - 1970; p=0.002) over the 7-year study period for Coffs Harbour. This reduction was not observed in Port Macquarie or in the rest of the state of NSW. Cumulative adjusted refractures rates for Coffs Harbour were as follows: 1-year 7%, 2-years 13%, 3-years 19%, 4-years 24%, 5 years 29%. Females had higher refractures rates compared to males and having a diagnosis of osteoporosis at time of index fracture was associated with higher refractures rates. <h3>Conclusion</h3> An FLS/ORP programme is associated with a reduction in total fractures and refractures rates. However, refracture rates were higher in Coffs Harbour, a rural centre, compared to pooled statewide data. <h3>Reference</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.